AIMS: Although 12 step recovery programs are widespread, their impact in reducing the risk of HIV among gay/bisexual men who abuse drugs and alcohol is unknown. The proposed study explores the effect of involvement of gay and bisexual men in community-based Alcoholics Anonymous, Narcotics Anonymous and Crystal Meth Anonymous on high HIV risk sexual behavior. The project will qualitatively explore mechanisms behind the association between program involvement and reduction in high HIV risk sexual behavior through semi-structured interviews and ethnographic observation. METHODS: Eighty program participants, defined as having attended at least two meetings in the previous week, will be interviewed in the first three months of recent attendance, followed via telephone contact and participant observation, and re-interviewed at six months. Ethnographic observation will be made at 12 step meetings. Half the participants will be recruited from Crystal Meth Anonymous with the remainder from AA and NA. ANALYSIS: We will qualitatively analyze all interviews and ethnographic observations in order to examine the links between drug/alcohol use; program affiliation, doctrines and tenets; and risky sexual behavior. We will explore discourses and scripts that men use to talk about sexuality and folk theories of the relationship between drinking/drug use and sexual risk behavior. Factors that appear to mediate and moderate the relationship between reported drug/alcohol use, risky sex, and program affiliation will be identified. In addition, at six months those who remain in the program will be compared with program dropouts in order to describe sexual risk behavior and drug/alcohol use. SIGNIFICANCE: This study will increase our understanding of the mechanisms within 12-step programs that affect high-risk sexual behavior and will lay the groundwork for future quantitative studies. We include Crystal Meth Anonymous due to the lack of studies of this program despite the growing need for specialized treatment for meth users. Where drug/alcohol use is associated with HIV risk behavior, the study will document that 12-step groups are an important referral resource for clinicians dealing with HIV. [unreadable] [unreadable] [unreadable]